David Stecher, MD, Bart de Boer, MD, Cornelis A. F

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Presentation transcript:

A new nonocclusive laser-assisted coronary anastomotic connector in a rabbit model David Stecher, MD, Bart de Boer, MD, Cornelis A.F. Tulleken, MD, PhD, Gerard Pasterkamp, MD, PhD, Lex A. van Herwerden, MD, PhD, Marc P. Buijsrogge, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 145, Issue 4, Pages 1124-1129 (April 2013) DOI: 10.1016/j.jtcvs.2012.05.061 Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Excimer laser-assisted nonocclusive anastomosis prototype anastomotic connector and laser catheter. A, Prototype anastomotic connector with 2 sharp pins (1) (6.2 mm length) attached to a ring (2) (2.6 mm inner diameter). B, Laser catheter (2.5 mm outer diameter): the grid of the vacuum channel (1) is located centrally and surrounded by laser fibers (2) (2.0 mm outer diameter). The outer band (3) (3.0 mm outer diameter) provides safety and stabilization into the ring of the anastomotic connector. The Journal of Thoracic and Cardiovascular Surgery 2013 145, 1124-1129DOI: (10.1016/j.jtcvs.2012.05.061) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Excimer laser-assisted nonocclusive anastomotic procedure in the rabbit abdominal aortic bypass model. A, The graft is mounted onto the connector using 6 stitches. The intima of the graft (highlighted) completely covers the inner surface of the ring of the connector. B, A standard needle holder (not shown) is used to insert the connector. The pins of the connector puncture the abdominal aortic wall. C, The pins penetrate outward again. The anastomotic circumference is sealed by a surgical sealant (not shown). D, Perpendicular positioning of the laser catheter (intima of the graft is highlighted). E, The catheter with a lasered fragment (“flap”) of the abdominal aortic wall (graft illustrated transparently). A small protruding adventitial rim of the abdominal aorta, the laser edge, is exposed intraluminally (see magnified section [complete coverage of the ring of the connector by the graft not shown]). F, Final abdominal aortic bypass with 2 anastomoses. Ligating hemoclips are placed at both ends of the graft, and a clip occludes the abdominal aorta in between the 2 anastomoses. The Journal of Thoracic and Cardiovascular Surgery 2013 145, 1124-1129DOI: (10.1016/j.jtcvs.2012.05.061) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Histologic sections of the Excimer laser-assisted nonocclusive anastomosis in the rabbit abdominal aortic bypass model. A, Longitudinal section at the middle of the anastomosis (12.5× magnification). The ring of the anastomotic connector is visible (1). A small protruding rim (2) of the abdominal aorta (R) is exposed to blood. No sealant (3) is in contact with the blood. G, lumen of the graft. B, Transverse section (12.5× magnification). The magnified (40×) subsection demonstrates the intima (I)–adventitia (A) vessel wall apposition and sharp laser-cut edge (Rim) with a streamlined cover of platelets and fibrin (F). G, Graft; R, recipient artery. The Journal of Thoracic and Cardiovascular Surgery 2013 145, 1124-1129DOI: (10.1016/j.jtcvs.2012.05.061) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions